Home Posts tagged "Diagnosis and Treatment of Movement Impairment Syndroms"

10 Reasons to Use Wall Slides

Today's guest post comes from my good friend and Elite Baseball Mentorships colleague, Eric Schoenberg. Enjoy! -EC

In response to the tweet below and in preparation for the upcoming CSP Elite Baseball Mentorship in June, we decided to put together an article dedicated to the wall slide.

In this article, we will discuss the top 10 findings from a wall slide assessment. In addition, we cover examples of how different coaching cues can benefit the athlete not only in their sport, but more so, in a particular moment in their sport.

This leads to the thought of using the term movement or “moment-specific” training rather than the overused “sport specific” terminology.

Here is the Tweet/question (thanks, Simon). The direct answer will come at the end of the article.

The wall slide was born through the work of Shirley Sahrmann and outlined in her book – Diagnosis and Treatment of Movement System Impairments.

Through many years of work and countless iterations, we have used and modified the pattern to allow for individualization of overhead activity in all body types and sports.

We use the wall slide as an assessment and an exercise every day with our athletes. It should be noted that the wall slide should serve as a bridge to any overhead activity (OH carries, landmine press, etc.) in your programming.

For each assessment finding using the Wall Slide Test, we use individual cues to assist the athlete in creating the desired movement correction. From there, we program the exercise into the warm-up or main program to help develop movement proficiency.

Here are ten reasons we use wall slides in our assessments:

1. Glenohumeral joint range of motion (ROM) – e.g. shoulder flexion

In the image below, we see Clint Capela and Andre Iguodala exhibiting adequate shoulder flexion, however, a slight lack of height, vertical jump, overhead strength, and timing may have resulted in the unfavorable result for AI.


Source: https://www.cbssports.com/nba/news/rockets-vs-warriors-clint-capela-meets-andre-iguodala-at-the-rim-with-incredible-two-handed-block/

2. Scapulo-thoracic joint ROM - e.g. scapular upward rotation and elevation

3. Cervical spine control – e.g. forward head tendency

4. Thoracic spine positioning – e.g. flat, extended vs. kyphotic, flexed

A clear illustration of the need to properly cue the Wall Slide and other overhead activities as it relates to the Thoracic Spine can be seen in the two pictures below.

a. OBJ’s catch shows elite thoracic extension in the overhead position. If Odell was an athlete that was more biased towards thoracic flexion, then his overhead mobility would be more limited and this iconic catch may have never happened. It is important to cue this pattern in the gym if it is required to happen on the field.


Source: https://ftw.usatoday.com/2014/11/odell-beckham-catch-new-york-giants-replay-youtube-vine-gif

b. In contrast, CSP athlete and St. Louis Cardinals All-Star Miles Mikolas does not require thoracic extension when his hand is fully overhead. In fact, he needs to be in a position of thoracic flexion to help deliver the scapula, arm, and hand at ball release. This pattern must also be trained.


Source: https://www.albanyherald.com/sports/cardinals-sign-pitcher-miles-mikolas-to--year-extension/article_7c3fec36-4408-5ce6-a053-3659320329c1.html

Note: This does not mean that Miles does not need thoracic extension to perform his job. It just means that he does not need to be trained into that position when his arm is fully overhead.

5. Lumbar spine positioning – e.g. excessive lumbar extension

6. Lumbo-pelvic stability – e.g. dropping into anterior pelvic tilt

7. Transverse plane alignment – e.g. spinal curvature or pelvic rotation

8. Lat length – e.g. athlete moves into humeral medial rotation at top of wall slide

In another example of the lat impacting overhead motion and movement quality, Rocky Balboa (not a CSP athlete, unfortunately!), shows a pattern of humeral medial rotation with overhead reaching. Interestingly, since his sport is not defined by vertical motion, but more so horizontal motion, Mr. Balboa does not require as much scapular upward rotation as a baseball player.


Source: https://www.phillyvoice.com/lesson-fake-news-faux-call-removal-rocky-statue/

 If we use the Pareto Principle (or the 80/20 rule), general fitness and athleticism should account for 80% of our training. However, the remaining 20% should be tailored to the movements, patterns, and positions that are unique to the athlete’s sport.

9. Motor Control - e.g. faulty scapulohumeral timing, inability to control scapulae eccentrically with arm lowering

10. Faulty activation patterns - e.g. overuse of upper trapezius vs. proper serratus and lower trapezius activation

In summary (and to answer the original question in the tweet above), the overhead reach (wall slide) is helpful to decrease upper trapezius involvement if the exercise is cued to do so. The ability to properly recruit serratus and lower trapezius to assist with scapular upward rotation will lessen the “need” for the upper trap to jump in too much. Remember, the upper trap does need to play a role in this movement, it just shouldn’t be doing all of the work.

As for the “extreme thoracic kyphosis” part…. It is important to first determine if this is a structural or functional issue. If it is structural, it will not change. In this case the wall slide can be used to train within this constraint to assist your client in finding solutions to get overhead. On the other hand, if the kyphosis is functional (meaning it can be changed), then the secret sauce is differentiating weakness, stiffness, shortness, and/or motor control issues as the reason for the kyphosis and difficulty getting overhead. The Wall Slide is a great tool to help tease that out to help your client.

If you want more information about this and many other aspects of the approaches that we utilize to manage the overhead athlete, please consider joining us June 23-25 at our Elite Baseball Mentorship program at CSP in Hudson, MA. The early-bird registration deadline is May 23.

This Cressey Sports Performance Elite Baseball Mentorship has a heavy upper extremity assessment and corrective exercise focus while familiarizing participants with the unique demands of the throwing motion. You’ll be introduced to the most common injuries faced by throwers, learn about the movement impairments and mechanical issues that contribute to these issues, and receive programming strategies, exercise recommendations, and the coaching cues to meet these challenges. For more information, click here.

About the Author

Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship courses at Cressey Sports Performance. He can be reached at eric@momentumpt.com.

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What the Strength and Conditioning Textbook Never Taught You: Synergists and Antagonists

As a follow-up to yesterday's "series premier," I wanted to use today's post to discuss another topic that rarely gets sufficient attention in the typical exercise science textbook: synergists and antagonists.

The typical explanation of the relationship of the two is that they're on opposite sides of the joint and perform opposite actions.  As an example, the hamstrings flex the knee, and quadriceps extend the knee.  Simple enough, right? Not so much.  

Muscles can be synergists and antagonists at the same time.  

Let's just look at the hip extensors to explain this point.  Your primary hip extensors are the hamstrings, gluteus maximus, and adductor magnus (there are more, but we're keeping this discussion simple).  They all work together to extend the hip each time you squat, lunge, deadlift, sprint, push the sled, or bust a move on the dance floor.  That said, the hip can do a lot of things as it extends.

glutemax

If we use more gluteus maximus and biceps femoris, it externally rotates and abducts a bit as we extend. If we use more adductor magnus, semitendinosis, and semimembranosus, it internally rotates and adducts.

Taking it a step further, as the hamstrings extend the hip, they have little control over the femoral head, so it tends to glide anteriorly in the acetabulum (hip socket) in a hamstrings-dominant hip extension pattern.  The glutes have more direct control over the femoral head and can posteriorly pull the head of the femur to avoid anterior hip irritation (usually the capsule). Shirley Sahrmann did a great job of outlining femoral anterior glide syndrome in her landmark book, Diagnosis and Treatment of Movement Impairment Syndromes.

sahrmann

Herein exists the issue: typical discussions of synergists and antagonists focus on things things:

1. Single planes of motion (sagittal, frontal, transverse), but not the interaction of multiple planes

2. Osteokinematics (gross movement of bones at joints: flexion/extension, abduction/adduction, internal/external rotation), rather than arthrokinematics (smaller movements at joint surfaces: rolling, gliding, spinning)

3. Active restraints (muscles, tendons), but not passive restraints (ligaments, bones, labra, intervertebral discs) that may be synergists to them in creating stability

As another example, think about stabilization at the glenohumeral (shoulder's ball and socket) joint.  There are a wide range of movements taking place, yet these movements must be controlled arthrokinematically in a very precise range via a complex system of checks and balances at the joint.  If the active restraints (primarily the rotator cuff) don't do their job, one could wind up with stretched/torn ligaments, a torn labrum, or bony defects.  In other words, it isn't a stretch (no pun intended) to say that muscles can be synergists to ligaments. Put that in your osteokinematic pipe and smoke it!

This is really a topic that deserves far more than a 500-word post; it could be an entire college curriculum in itself!  And, the more you can understand it, the better you'll be able to help your clients and athletes. A great resource to get the ball rolling in this regard is Building the Efficient Athlete, a two-day seminar Mike Robertson and I filmed with functional anatomy heavily in mind.  

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Down on Lumbar Flexion in Strength Training Programs? Enter the Reverse Crunch.

The other day, I got an email from another fitness professional saying that he really liked my Maximum Strength training program, but that he'd have left out the reverse crunches if it was his strength training program because he "doesn't use any lumbar flexion work" in his programming anymore.

Given that the book was published in 2008, I'd gather that he is under the assumption that I've jumped on board the anti-flexion bandwagon that's been piling up members in droves over the past 3-4 years.  That perception certainly has backing.  Afterall, if you want to herniate a disc, go through repeated flexion and extension at end range.  If you want to see a population of folks with disc herniations, just look at people who sit in flexion all day; it's a slam dunk.

And, you certainly don't want to go into lumbar flexion with compressive loading.  As far back as 1985, Cappozzo et al. demonstrated that compressive loading on the spine during squatting increased with lumbar flexion.

These points in mind, I'm a firm believer that you should avoid:

a) end-range lumbar flexion

b) lumbar flexion exercises in those who already spend their entire lives in flexion

c) lumbar flexion under load

It seems pretty cut and dry, right?  Don't move your lumbar spine and you'll be fine, right? Tell that to someone who lives in lumbar hyperextension and anterior pelvic tilt.  Let me make that clearer:

Flexion from an extended position to "neutral" is different than flexion from "neutral" to end-range lumbar flexion.

In the former example, we're just taking someone from 20 yards behind the starting line up to the actual starting line.  In the latter example, we're taking someone from the starting line, through the finish line, and then violently through the line of people at the snack shack 50 yards past the finish line as nachos and Italian ice fly everywhere and the spectators scurry for cover.  You get a gold star if you take out the band, too.

If you're someone who trains predominantly middle-aged to older adult clients, by all means, nix flexion exercises.  However, I deal with loads of athletes - most of whom live in lumbar extension and anterior pelvic tilt.

Now, I'll never be a guy who has guys doing sit-ups or crunches, as they can shorten the rectus abdominus, thereby pulling the rib cage down when we're working hard to improve thoracic extension and rotation.  Additionally, most athletes absolutely crank on the neck with these - and that leads to a host of other problems.

For reasons I outlined in a recent post, Hip Pain in Athletes: The Origin of Femoroacetabular Impingement, we need to work to address anterior pelvic tilt and excessive lumbar extension - which can lead to a "pot belly" look even in athletes who are quite lean.

Enter the reverse crunch, which selectively targets the external obliques over the rectus abdominus.  As Shirley Sahrmann wrote in Diagnosis and Treatment of Movement Impairment Syndromes, "The origin of this muscle from the rib cage and its insertion into the pelvis are consistent with the most effective action of this muscle, that is, the posterior tilt of the pelvis."

We utilize the reverse crunch as part of a comprehensive anterior core strengthening program that also includes progresses from prone bridging variations to rollout variations and TRX anterior core work (and, of course, anti-rotation exercises to improve rotary stability).  And, I can say without hesitate that this addition was of tremendous value to an approach that got cranky baseball hips and spine healthier faster than ever before at Cressey Performance.

In summary, remember that flexion isn't the devil in a population that lives in extension. Contraindicate the person, not the exercise.

To learn more about our comprehensive approach to core stabilization, be sure to check out Functional Stability Training of the Core.

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